This is an archived article that was published on sltrib.com in 2012, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

The Patient Protection and Affordable Care Act was passed by Congress. It was signed by the president. It was upheld by the Supreme Court. And it was, quite clearly, ratified by a majority of the American electorate just last month.

The ongoing attempts by the state of Utah to somehow wriggle out of some of the law's basic requirements are both embarrassing and counterproductive. Efforts by Gov. Gary Herbert to expand the Medicaid program only a fraction as much as the law envisions, or to get approval for a state insurance exchange that falls far short of federal standards, seem devoted less to saving money than to denying the need for a new system that actually provides health care coverage to the millions of Americans, and the 378,000 Utahns, who have gone without for far too long.

It is that goal of expanding health care coverage  which twice propelled Barack Obama to the White House, solidified Democratic control of the Senate and saw Democratic House candidates win a total of a half-million more votes than Republican House candidates  that Herbert and others in Utah seem to forget, at their peril, and ours.

The governor can be forgiven for his frustration at the fact that the federal bureaucracy is still furiously writing rules for a law passed more than two years ago. He is within his rights to be peeved that President Obama promises flexibility without fully answering his questions.

But, despite all the devils in the details, the goal of the ACA remains clear: providing health insurance to as many people as we possibly can. Every other nation that even flirts with the definition of civilized has long accepted that as a base requirement. And the ACA is, so far, as close as this nation has come to providing it.

An independent review by the Kaiser Family Foundation concludes that expanding Medicaid coverage as directed by the ACA  to households earning as much as 138 percent of the federal poverty level  will cost states very little because the lion's share of the expansion will be borne by the federal government. The study gives very little mathematical support to the idea, floated by Herbert and the governors of several other states, that states should be allowed to only expand their Medicaid eligibility by a fraction of that envisioned by the ACA.

Fully expanded Medicaid, especially for children, and federally subsidized private health insurance, especially for working adults, will see more people covered, fewer uninsured people clogging hospital emergency rooms and a significantly reduced number of people who can't pay for the care they do get, which means less shifting of costs to hospitals and insurance companies.

By Kaiser's figures, total acceptance of expanded Medicaid coverage limits will cost the states, altogether, $76 billion over 10 years. But they will spend $68 billion, only $8 billion less, over that decade if no state expands Medicaid and simply tries to absorb the coming additional case load under the existing system. Giving credit for the billions of dollars in hospital bills that would be paid under full implementation of the ACA, rather than left unpaid by uninsured patients, Kaiser figures that the 50 states and the District of Columbia will spend $10 billion less on health care between 2013 and 2022 than they would without Medicaid expansion.

Utah, which has a relatively low level of uncompensated care, would not fare quite as well as the nation as a whole. But it would still be able to cover a much higher percentage of its population at a net increased cost of only 2.9 percent.

The numbers should make it clear what Utah should be doing. It should fully expand Medicaid and gladly accept the additional federal dollars that will pay for nearly all of it. It should either offer an insurance exchange worthy of the name, or step aside and let the feds do it.

What Utah should not do is claim that it has a better idea on how to cover a shamefully high level of uninsured families or, worse, pretend it doesn't matter.